title: First Spanish version of the Memorial Delirium Assessment Scale: psychometric properties, responsiveness, and factor loadings.
abstract: BACKGROUND
  The Memorial Delirium Assessment Scale (MDAS) is a reliable and validated instrument with which to assess delirium. However, MDAS responsiveness has only been investigated in an indirect way. Also, neurobehavioral and global cognitive factors seem to be the MDAS main factor loads.
  
  
  OBJECTIVE
  The primary objective of this study was to evaluate MDAS responsiveness and analyze individual factors on this scale. The secondary objective was to confirm concurrent validity and reliability of the Spanish version of the MDAS.
  
  
  METHODS
  The translation-back translation method was used to obtain the Spanish version of the MDAS. Delirium diagnosis was determined by the clinical Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria and with the Confusion Assessment Method. Responsiveness and factor loadings were determined with the Delirium Rating Scale-Revised-98, the Mini-Mental State Examination (MMSE), and the MDAS at baseline (0 hours) and at 72 hours.
  
  
  RESULTS
  Variation in the scores of the Delirium Rating Scale-Revised-98 shows a correlation of r = 0.93, with variation in MDAS scores at P < 0.001. Variation in MMSE scores shows a correlation of r = -0.84, with variation in MDAS scores at P = 0.015. Factor I, neurobehavioral (reduced awareness, reduced attention, perceptual disturbance, delusions, altered psychomotor activity, and sleep-wake cycle disturbance), correlated moderately with the MMSE at -0.56. Factor II, global cognitive (disorientation, short-term memory impairment, impaired digit span, and disorganized thinking), correlated strongly with the MMSE at -0.81. Factor II was significantly more reliable than Factor I, rho = 0.7, P = 0.01.
  
  
  CONCLUSIONS
  The high responsiveness confirms the value of the MDAS for ongoing delirium assessment. Two differentiated factor loadings point to a potential future need for MDAS subscales.
authors.affiliation: Hospital Centro de Cuidados Laguna, Madrid, Spain; Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA. Electronic address: anoguera@lagunacuida.org.
authors.forename: Antonio
authors.initials: A
authors.lastname: Noguera
authors.affiliation: Equipo de Soporte Hospitalario y Medicina Paliativa, Clínica Universitaria, Universidad de Navarra, Pamplona, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Carvajal
authors.affiliation: Unidad de Agudos de Cuidados Paliativos, Hospital Universitario La Paz, Universidad Autónoma, Madrid, Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: Alonso-Babarro
authors.affiliation: Department of Biostatistics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Gary
authors.initials: G
authors.lastname: Chisholm
authors.affiliation: Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bruera
authors.affiliation: Equipo de Soporte Hospitalario y Medicina Paliativa, Clínica Universitaria, Universidad de Navarra, Pamplona, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Centeno
mesh_terms: D000368:Aged; D003693:Delirium / Q000150:complications / Q000175:diagnosis*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D007802:Language; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications; D009483:Neuropsychological Tests; D010166:Palliative Care; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics; D015203:Reproducibility of Results
keywords: Delirium; assessment; cancer; monitoring; questionnaires